Policy Implications: Neighborhoods

“African Americans were unconstitutionally denied the means and the right to integration in middle-class neighborhoods, and because this denial was state-sponsored, the nation is obliged to remedy it” (Rothstein, preface XIV)

Reparations for exclusionary housing policies and resultant racial wealth and health inequities

In The Case for Reparations, Ta-Nehisi Coates describes the evolving nature of racist policies and practices which continue to negatively impact Black Americans, demonstrating through story and statistics how the scales have yet to be balanced: “Having been enslaved for 250 years, black people were not left to their own devices. They were terrorized. In the Deep South, a second slavery ruled. In the North, legislatures, mayors, civic associations, banks, and citizens all colluded to pin black people into ghettos, where they were overcrowded, overcharged, and undereducated. Businesses discriminated against them, awarding them the worst jobs and wages. Police brutalized them in the streets. And the notion that black lives, black bodies, and black wealth were rightful targets remained deeply rooted in the broader society. Now we have half-stepped away from our long centuries of despoilment, promising, ‘Never again.’ But still, we are haunted. It is as though we have run up a credit-card bill and, having pledged to charge no more, remain befuddled that the balance does not disappear. The effects of that balance, interest accruing daily, are all around us.”

In The Color of Law, Richard Rothstein demonstrates that today’s residential segregation patterns directly result from explicit government policies that created and maintained the geographic separation of Black and white families in the United States (i.e., de jure discrimination). These patterns did not happen accidentally, by chance, or due to a few racist individuals (i.e., de facto discrimination). Therefore, the problem requires de jure solutions – explicit re-segregation and anti-segregation policies.

The Century Foundation proposes a four-part strategy to address the lasting impact of racial residential segregation on the health of our communities in four key facets of Black-white segregation.

In addition, some health departments are working to address foreclosure as part of their commitment to health equity (Schaff & Dorfman, 2019). 

Health in All Policies (HiAP)

The Health in All Policies (HiAP) approach seeks to center health equity in developing and implementing policies that impact neighborhood characteristics and quality. As described by the Centers for Disease Control and Prevention, “Health in All Policies (HiAP) is a collaborative approach that integrates and articulates health considerations into policymaking across sectors to improve the health of all communities and people.” The HiAP approach is born out of the dual recognition that (a) social, economic, and environmental factors have profound impacts on health and well-being and (b) the policies which impact those sectors do not fall under the purview of health departments and the traditional public health sector (Hall & Jacobson, 2018). Therefore, policymakers who can influence the sectors affecting the social determinants of health “are informed about the health, equity, and sustainability consequences of various policy options during the policy development process” (HiAP Guide, p.6). As described in the HiAP Guide, five critical elements of all HiAP approaches are as follow:

  • Promote health, equity, and sustainability
  • Support intersectoral collaboration
  • Benefit multiple partners
  • Engage stakeholders
  • Create structural or procedural change

HiAP Resources

Urban Institute – How to Put Racial Equity at the Center of Neighborhood Investment